Wetread Case 35
Hx: chest and neck pain.
What are the important findings? Recommendations?
Diagnosis? 🤔
Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
Hx: chest and neck pain.
What are the important findings? Recommendations?
Diagnosis? 🤔
Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
We can see on our current exam that the contour of the aortic silhouette (red arrow) is maintained thus it should not be adjacent to the aorta. If fact it actually obscures the left subclavian artery silhouette (yellow arrows) so it has to be in the anterior mediastinum.
What next? Contrasted CT Neck of course.
We clearly see the extensive stranding throughout the anterior mediastinal fat, with severe narrowing of the left bracheocephalic vein and left jugular vein.
If you are observant you may see narrowing on the R as well 😉
We clearly see the extensive stranding throughout the anterior mediastinal fat, with severe narrowing of the left bracheocephalic vein and left jugular vein.
If you are observant you may see narrowing on the R as well 😉
So is it external compression or internal thrombosis narrowing these veins? Doppler US clearly shows occlusive thrombus as low as we could go. CT/MR better for intrathoracic evaluation.
So what could be the etiology of this?
Here is a slice from higher up on the Neck CT showing retropharyngeal fluid c/w with clinical suspicion of oropharyngeal infection
In summary we have a variant of Lemierre's Syndrome
Here is a slice from higher up on the Neck CT showing retropharyngeal fluid c/w with clinical suspicion of oropharyngeal infection
In summary we have a variant of Lemierre's Syndrome
Lemierre's Syndrome (1/3):
Infectious thrombophlebitis of the internal jugular vein in the setting of pharyngitis/tonsilitis
-Male predominance
-generally 16-25 years old
-80% caused by Gram (-) Fusobacterium necrophorum but can be polymicrobial even including MRSA
Infectious thrombophlebitis of the internal jugular vein in the setting of pharyngitis/tonsilitis
-Male predominance
-generally 16-25 years old
-80% caused by Gram (-) Fusobacterium necrophorum but can be polymicrobial even including MRSA
Rad findings of Lemierre's syndrome (2/3):
Jugular vein thrombosis. US generally easiest and most straight forward but can be limited within the chest
CT/MR helpful for more central venous evaluation and to identify source/site of primary infection (pharyngeal or tonsillar)
Jugular vein thrombosis. US generally easiest and most straight forward but can be limited within the chest
CT/MR helpful for more central venous evaluation and to identify source/site of primary infection (pharyngeal or tonsillar)
Lemierre's Syndrome (3/3):
Complications: Pulmonary Septic emboli and systemic dissemination
Treatment: Anticoagulation and IV Abx. Mortality rates can be as high at 18%.
Complications: Pulmonary Septic emboli and systemic dissemination
Treatment: Anticoagulation and IV Abx. Mortality rates can be as high at 18%.
